学龄前哮喘儿童肺通气功能特征分析

doi:10.12372/jcp.2024.23e0356

Abstract

Abstract:

Objective To investigate the distribution characteristics of spirometry in preschool asthmatic children and further analyze its characteristics. Methods The clinical information and lung function results of preschool asthmatic children who were initial diagnosed from January 2019 to December 2020 were retrospectively collected. Latent profile analysis (LPA) was applied to analyze the category features of spirometry parameters distribution. The ordinal logistic regression analysis was used to analyze the relationship between the difference factors and category features of spirometry. Results A total of 851 preschool asthmatic children were included in this study, with a median age of 4.3 years. Latent profile analysis of spirometry parameters (FEV₁, FEV₁/FVC, FEF₅₀, FEF₇₅ and FEF_25~75, %pred) fitted four categories of spirometry parameters distribution curves: above-normal lung ventilation function group (118 cases, 13.9 %), normal lung ventilation function group (269 cases, 31.6 %), small airway function decreased group (297 cases, 34.9 %) and small airway dysfunction group (167 cases, 19.6 %). Spirometry parameters values showed a downward trend among the four category groups, with statistically significant differences in small airway function parameters among groups (P<0.001). Compared with the above-normal lung ventilation function group and the normal lung ventilation function group, patients in the small airway dysfunction group were older (P<0.001), had a higher proportion of eosinophilia (P=0.040) and severe airway hyperresponsiveness (AHR, P<0.001). The ordinal logistic regression analysis showed blood eosinophilia (P=0.036), moderate airway hyperresponsiveness (P=0.008), and severe airway hyperresponsiveness (P<0.001) were positively correlated with small airway dysfunction in preschool asthmatic children. Conclusions The distribution characteristics of spirometry parameters in preschool asthmatic children can be categorized into four types: above-normal lung ventilation function, normal lung ventilation function, small airway function decreased and small airway dysfunction. Blood eosinophilia and airway hyperresponsiveness are associated with small airway dysfunction in preschool children with asthma.

Key words: asthma, spirometry, child

YI Liangqin, YANG Jingyi, ZHAO Yan, ZHANG Xi, HE Yiting, TIAN Xiaoyin, ZHANG Guangli, LIU Sha, LUO Zhengxiu. Characteristics of lung function in preschool asthmatic children[J].Journal of Clinical Pediatrics, 2024, 42(11): 927-934.

Figures/Tables 4

项目	高于正常肺通气功能组(n=118)	肺通气功能正常组 (n=269)	小气道功能下降组 (n=297)	小气道功能障碍组 (n=167)	统计量	P
年龄[M(P₂₅~P₇₅)]/岁	4.2(3.7~4.8)	4.3(3.9~4.9)	4.4(3.9~5.1)¹⁾	4.5(4.1~5.2)²⁾	H=22.15	<0.001
男童[n(%)]	71(60.2)	146(54.3)	168(56.6)	104(62.3)	χ²=3.15	0.369
体质指数[M(P₂₅~P₇₅)]/ kg·m^-2	16.0(15.4~16.8)	16.1(15.3~17.1)	16.1(15.1~17.1)	15.7(15.0~16.8)	H=5.16	0.160
哮喘家族史[n(%)]	10(8.5)	19(7.1)	35(11.8)	18(10.8)	χ²=4.05	0.256
过敏性鼻炎[n(%)]	58(49.2)	135(50.2)	141(47.5)	78(46.7)	χ²=0.66	0.882
湿疹史[n(%)]	26(22.0)	70(26.0)	88(29.6)	42(25.1)	χ²=2.88	0.412
特应性体质[n(%)]	65(55.1)	164(60.9)	165(55.6)	95(56.9)	χ²=2.84	0.417
嗜酸性粒细胞增多症[n(%)]	26(22.0)	63(23.4)	72(24.2)	55(32.9)³⁾	χ²=8.31	0.040
cMch[M(P₂₅~P₇₅)]/g·L^-1	8.0(2.0~8.0)	2.0(2.0~8.0)	2.0(2.0~8.0)²⁾	2.0(2.0~2.0)³⁾	H=58.11	<0.001
AHR[n(%)]	107(90.7)	258(95.9)	272(91.6)	116(69.5)	χ²=76.77	<0.001
极轻度	11(10.3)	22(8.5)	13(4.8)	4(3.4)
轻度	52(48.6)	98(38.0)	81(29.8)¹⁾	21(18.1)²⁾
中度	44(41.1)	130(50.4)	157(57.7)¹⁾	66(56.9)¹⁾
重度	0(0.0)	8(3.1)	21(7.7)¹⁾	25(21.6)²⁾
肺通气功能参数（%pred） [M(P₂₅~P₇₅)]
FVC	98.95 (91.20~110.30)	95.40 (87.95~104.15)	94.50 (87.45~103.55)¹⁾	89.30 (79.30~97.20)³⁾	H=54.89	<0.001
FEV₁	113.15 (102.38~122.50)	103.80 (97.30~111.60)	97.20 (90.85~104.35)²⁾	83.00 (74.90~90.10)³⁾	H=357.58	<0.001
FEV₁/FVC	112.90 (111.30~114.00)	109.30 (106.20~111.85)	102.50 (99.10~105.30)²⁾	93.50 (89.30~97.20)³⁾	H=557.72	<0.001
PEF	102.15 (92.88~113.53)	88.80 (82.15~99.10)	82.30 (75.50~92.35)²⁾	72.70 (64.20~80.40)³⁾	H=298.66	<0.001
FEF₅₀	116.10 (109.30~124.63)	93.40 (86.70~100.30)	71.30 (65.60~77.70)²⁾	50.90 (43.20~56.10)³⁾	H=723.63	<0.001
FEF₇₅	125.65 (117.48~139.83)	90.70 (82.55~101.55)	65.40 (58.20~71.20)²⁾	41.40 (33.30~46.80)³⁾	H=737.84	<0.001
FEF_25~75	120.75 (116.15~132.05)	95.10 (89.50~102.05)	72.80 (66.95~77.95)²⁾	49.90 (43.10~54.30)³⁾	H=770.55	<0.001

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模型	K	Log（L）	AIC	BIC	aBIC	LMR	BLRT	Entrophy	类别概率	类别人数及比例
剖面一	10	-18475.439	36970.879	37018.343	36986.586
剖面二	16	-17390.132	34812.263	34888.206	34837.395	<0.0001	<0.0001	0.880	0.521/0.479	443/408
剖面三	22	-16779.653	33603.306	33707.727	33637.862	0.0540	<0.0001	0.900	0.253/0.261/0.486	215/222/414
剖面四	28	-16388.100	32832.200	32965.100	32876.180	0.0003	<0.0001	0.921	0.196/0.316/ 0.139/0.349	167/269/ 118/297
剖面五	34	-16210.098	32488.196	32649.574	32541.600	0.0220	<0.0001	0.924	0.193/0.289/ 0.327/0.143/0.048	164/246/ 278/122/41

模型		因素	β	SE	Wald χ²值	OR	95%CI	P
阈值	Y	高于正常肺通气功能组	-0.898	0.377	5.682	0.407	0.195~0.852	0.017
		肺通气功能正常组	0.938	0.376	6.221	2.555	1.223~5.344	0.013
		小气道功能下降组	2.745	0.396	48.020	15.565	7.162~33.840	<0.001
位置	X1	嗜酸性粒细胞增多症	0.374	0.179	4.388	1.454	1.024~2.064	0.036
	X2	气道高反应性
		重度^1）	2.362	0.508	21.636	10.612	3.923~28.718	<0.001
		中度^1）	1.040	0.392	7.024	2.829	1.311~6.101	0.008
		轻度^1）	0.237	0.399	0.354	1.267	0.580~2.768	0.552

Characteristics of lung function in preschool asthmatic children

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